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Papers by Sotiris Papaspyros

Journal of Cardiothoracic Surgery, 2015

Over the past two centuries the surgical profession has undergone a profound evolution in terms o... more Over the past two centuries the surgical profession has undergone a profound evolution in terms of efficiency and outcomes. Societal concerns in relation to quality assurance, patient safety and cost reduction have highlighted the issue of training expert surgeons. The core elements of a training model build on the basic foundations of gross and fine motor skills. In this paper we provide an analysis of the ergonomic principles involved and propose relevant training techniques. We have endeavored to provide both the trainer and trainee perspectives. This paper is structured into four sections: 1) Pre-operative preparation issues, 2) technical skills and instrument handling, 3) low fidelity simulation models and 4) discussion of current concepts in crew resource management, deliberate practice and assessment. Rehearsal, warm-up and motivation-enhancing techniques aid concentration and focus. Appropriate posture, comprehension of ergonomic principles in relation to surgical instruments and utilisation of the non-dominant hand are essential skills to master. Low fidelity models can be used to achieve significant progress through the early stages of the learning curve. Deliberate practice and innate ability are complementary to each other and may be considered useful adjuncts to surgical skills development. Safe medical care requires that complex patient interventions be performed by highly skilled operators supported by reliable teams. Surgical ergonomics lie at the heart of any training model that aims to produce professionals able to function as leaders of a patient safety oriented culture.

The Annals of Thoracic Surgery, 2015

International journal of surgery (London, England), Jan 20, 2015

Open Journal of Thoracic Surgery, 2012

We present a case of a rarely seen anomalous circumflex (Cx) artery originating from the proximal... more We present a case of a rarely seen anomalous circumflex (Cx) artery originating from the proximal right coronary artery. This was an incidental finding during a diagnostic coronary angiogram performed to investigate a patient with acute coronary syndrome. Surgically significant disease was present in four left-sided vessels. The patient underwent coronary artery bypass grafts using left internal thoracic artery and long saphenous vein grafts to all four left sided vessels including the aberrant Cx. We also present a discussion of current relevant literature and guidelines in relation to definition, classification, incidence, diagnosis, clinical relevance and treatment of this type of coronary artery anomalies.

British Journal of Cardiac Nursing, 2011

Journal of Cardiothoracic Surgery, 2008

Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. Their i... more Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. Their incidence in the esophagus is 1%-3%. Never has a GIST been documented to directly invade the lung. We report a primary esophageal GIST with direct invasion into the lung parenchyma, presenting predominantly with respiratory symptoms. We include a retrospective literature review. Although the principle 'common things are common' usually guides our everyday clinical practice, this case emphasizes that rare entities can mimic common pathologies and underlines the importance of having a clearly defined differential diagnostic list which should be meticulously scrutinized.

European Journal of Cardio-Thoracic Surgery, 2008

Background: A rising number of acute hospitals in the UK have been providing patients with bedsid... more Background: A rising number of acute hospitals in the UK have been providing patients with bedside entertainment services (BES) since 1995. However, their effect on postoperative patient mobility has not been explored. Objectives: The aim of this prospective randomised clinical trial was to compare the level of postoperative physical activity and length of in-hospital stay of patients undergoing cardiac surgery depending on whether they had access to BES or not. Methods: One hundred patients requiring elective cardiac surgery were randomised to receive access to BES (52 patients) or not (48 patients). Pedometers were used to quantify postoperative physical activity for 5 days. To assess the significance of the effect of intervention (TV off or on) on the pedometer counts over time a mixed effect Poisson regression model is used, with the time varying aspect as random component. The potential influence of gender difference and age on pedometer counts were assessed by incorporating these two factors as covariates in the Poisson model. Results: On average, patients with no access to BES walked more than those with BES access. This difference ranged between 192 and 609 steps in favour of the first group for each individual postoperative day. Patients with no access to BES were 84% more likely (risk ratio: 1.84, 95% CI: 1.29-2.63) to walk higher number of steps than patients with access to BES. On average, participants with access to BES were likely to stay longer in hospital (median of 7 days with interquartile range 6-7 days), than participants with no access to BES (median of 6 days with interquartile range 5-7 days), however the difference did not reach statistical significance. Conclusion: We have demonstrated that the bedside entertainment systems may have an adverse effect on post cardiac surgery patient ambulation and may contribute to an increase in hospital stay. #

European Journal of Cardio-Thoracic Surgery, 2012

OBJECTIVES: The role of coronary endarterectomy (CE) in modern cardiac surgery has been an extant... more OBJECTIVES: The role of coronary endarterectomy (CE) in modern cardiac surgery has been an extant debate as coronary artery bypass grafting (CABG) has advanced. However, as cardiac surgeons are being referred ever more complex coronary disease for surgical correction, adjunctive strategies may need re-evaluation. The long-term results of CE are largely unknown. We present the longest cohort follow-up in a single institution looking at our 20-year experience of CEs employed as an adjunct to CABG in diffuse coronary artery disease.

European Journal of Cardio-Thoracic Surgery, 2009

Compliance with the European Working Time Directive has made obvious the need for a surgical skil... more Compliance with the European Working Time Directive has made obvious the need for a surgical skills training system that will produce surgeons fast and reliably. We have previously proposed a model for objective assessment of surgical dexterity. In this paper we aim to place an updated version of that model into the context of a holistic approach on assessment of a trainee&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s progress towards becoming an independently operating surgeon. The PAR matrix breaks down an operation into clearly defined skills that need to be successively acquired. It consists of a 3 x 6 table depicting 18 skill-goals. The y-axis is divided into six levels and the x-axis into three columns. The initials of the three skills on each level form the acronym PAR. Each skill is further graded from 1 to 3 (unsatisfactory, competent, good). The levels are: Level 1--posture, address, relaxation; Level 2--pick-up, airtime, rotation; Level 3--placing, angles, rhythm; Level 4--precision, adaptability, reproducibility; Level 5--pace, awareness, relations; Level 6--planning, announce, review/reflexion. The format of the PAR model is such that it allows trainer and trainee to objectively assess progress, identify deficiencies and strengths and formulate an appropriate plan of action. Ergonomics and crew resource management skills are essential for a safe operating environment. The PAR matrix may prove helpful in selection of trainees and revalidation of trainee surgeons as a competence and performance testing method, placed in the appropriate training curriculum.

Error in health services delivery has long been recognised as a significant cause of inpatient mo... more Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A troublefree operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

Journal of Cardiothoracic Surgery, 2010

Introduction: Keloid scars following median sternotomy are rare and occur more frequently in pigm... more Introduction: Keloid scars following median sternotomy are rare and occur more frequently in pigmented skin. Different management strategies have been described with variable success. We present a case of keloid scar formation following cardiac surgery including our management and the final aesthetic result. Case description: A 64 year old female of fair complexion underwent mitral valve replacement. The procedure and postoperative recovery were uncomplicated, however, during the following year, thick keloid scars formed over the incision sites. Initial non surgical measures failed to relieve pain and did not offer any tangible aesthetic benefit. Eventually surgical excision was attempted. She presented to our clinic for nine months follow up with significant improvement in pain and aesthetic result. Discussion and Evaluation: Several theories have attempted to explore the pathophysiology of keloid scar formation. A number of predisposing factors have been documented however none existed in this case. A variety of invasive and non invasive approaches have been described but significant differences in success rates and methodology of investigations still precludes a standardized management protocol. Conclusions: In this case study a rare presentation of keloid scar has been presented. The variety of methods used to improve pain and aesthetic result demonstrates the propensity of keloid scars to recur and the therapeutic challenges that surgeons have to face in their quest for a satisfactory patient outcome.